Management of ulnar collateral ligament injury in baseball athletes: An online survey in Japanese surgeons.

BACKGROUND: The management of ulnar collateral ligament (UCL) injuries widely varies among surgeons. Although various treatment options have been proposed including surgical and conservative treatments, no golden standard treatment strategy has been established of yet. The American survey reported an overall experienced and well-trained cohort of surgeons often reached consensus opinions on how to approach UCL injury. However, the consensus among Japanese surgeons on the treatment of UCL injuries remains unclear. The purpose of this study was to survey current trends among Japanese orthopaedic surgeons in the treatment of UCL injuries in baseball players. METHODS: An online survey was distributed to the active members of the Japanese doctor's network for baseball injury prevention, which was formed by partial members of the medical committee in the Japan Baseball Council. The survey was composed of three sections: demographics of the surveyees, preferred operative and nonoperative management of UCL injuries, and five fictional clinical case scenarios of baseball players with a UCL injury. RESULTS: The 131 e-mailed invitations to society members yielded 78 completed online surveys with a participation rate of 60%. Sixty-four respondents (82%) reported >15 years of clinical experience. Sixty-five respondents (83%) performed ≤5 UCL reconstructions per year. As nonsurgical management of UCL injuries, seventy-four surgeons (95%) preferred physiotherapy followed by intraarticular injection (46%). For surgical management, seventy-three surgeons (93%) preferred UCL reconstruction. Of the five case scenarios, a consensus was reached in three cases: to perform surgery on the patient with full-thickness UCL tear. When operative management was the preferred option, a consensus was reached to perform UCL reconstruction. CONCLUSION: Japanese doctors involved in the treatment of baseball injuries reached a consensus to indicate high-level athletes with a full-thickness UCL tear for surgery. When operative management was the preferred option, a consensus was reached to perform UCL reconstruction. These results may contribute to the decision-making for managing UCL injuries.

Prospective study on antimicrobial prophylaxis in total hip arthroplasty.

AIMS AND BACKGROUND: Prophylactic use of antibiotics against the pathogens likely to contaminate the procedure is considered beneficial to prevent surgical site infections. We asked that an increase in the effective blood concentration by increasing the administration dose immediately before the operation can decrease the incidence of surgical site infection and performed a prospective study in patients undergoing total hip arthroplasty. METHODS: The subjects consisted of 357 patients who underwent initial THA between January 2006 and June 2012. We compared 172 patients who received an initial dose of Unasyn-S 1.5 g (1.5-g group) and 185 treated after January 2010 when the initial dose alone was increased to 3.0 g (3.0-g group) in terms of the incidence and depth (superficial or deep layer) of SSI. RESULTS: SSI developed in 7 (1.96 %) of all patients, consisting of 5 (2.91 %) in the 1.5-g group and 2 (1.08 %) in the 3.0-g group. Its incidence did not differ between the two groups, but was slightly lower in the 3.0-g group. Deep infection was observed in 2 of the 5 patients in the 1.5-g group but neither of the 2 in the 3.0-g group. CONCLUSION: Although there is statistically no significant difference in the incidence of SSI, our data suggest that an increase of the preoperative antibiotics reduces the incidence of SSI and can be an effective measure for the prevention of infection.

Clinical features and treatment outcomes of Fournier's gangrene in a single tertiary emergency hospital: Simplified Fournier's Gangrene Severity Index score is a predictor for death.

To assess the predictive reliability of the Simplified Fournier's Gangrene Severity Index Score (SFGSI) for mortality in Japanese patients with Fournier's gangrene (FG), we compared the clinical features and outcomes of a patient sample with the SFGSI. The medical records of 36 patients diagnosed with FG at our hospital between October 2007 and September 2022 were reviewed retrospectively. Clinical and laboratory variables, including SFGSI, were evaluated and predictive factors for fatality were investigated using multivariate logistic regression analysis. The median age and body mass index were 65 and 24.2, respectively. Eight patients had cooccurring chronic kidney disease and 23 had diabetes. None were taking sodium-glucose co-transporter-2 (SGLT-2) inhibitors. The causative organisms were diverse, and no specific trends in causative organisms were observed. 26 patients underwent debridement of necrotic tissue including eight colostomies, two orchiectomies, and one cystectomy. Multivariate logistic regression analysis revealed that SFGSI alone was an independent predictor of case fatality, with an odds ratio of 20.167 (95% CI: 1.66-245.53). In conclusion, the fatality rate was 19.4%, which was comparable to that reported in other studies. The SFGSI was an independent predictor of mortality in this study.

Heterogeneously vancomycin-intermediate Staphylococcus aureus (hVISA) emerged before the clinical introduction of vancomycin in Japan: a retrospective study.

Vancomycin-intermediate Staphylococcus aureus (VISA) and its precursor, heterogeneous VISA (hVISA), are increasingly the cause of vancomycin treatment failure. Prolonged glycopeptide treatment causes the emergence of these pathogens. However, we recently reported that hVISA can be generated by methicillin-resistant S. aureus (MRSA) exposure to imipenem (Katayama et al., Antimicrob Agents Chemother. 53:3190-6). We report here a retrospective prevalence study of VISA and hVISA on 750 MRSA clinical strains isolated from 31 Japanese national university hospitals in 1990, the year before the introduction of injectable vancomycin into clinical use in Japan in 1991. No VISA strain was identified, but population analysis identified 38 hVISA strains (5.1%) from 19 hospitals. We also determined the nucleotide sequences of vraSR, walRK, clpP, and rpoB genes whose mutations are known to be associated with vancomycin resistance. When compared with vancomycin-susceptible MRSA strain N315, six of the 38 hVISA strains possessed nonsynonymous mutations in vraSR, seven in walRK, and two in rpoB genes, Thirteen of 38 (34.2%) hVISA strains possessed at least one of these mutations. Results were consistent with our hypothesis that hVISA was present in Japanese hospitals before the clinical introduction of vancomycin.

Does scapular dyskinesis affect top rugby players during a game season?

BACKGROUND: Scapular dyskinesis represents a considerable risk of shoulder injury to overhead athletes; however, there is a shortage of detailed epidemiologic information about scapular dyskinesis among the participants in collision sports. PURPOSE: To describe the incidence and relationship of scapular dyskinesis to shoulder discomfort and variables related to the shoulder in top rugby players. METHODS: One hundred twenty top rugby football players in Japan were evaluated by means of questionnaires, physical examinations, and a video analysis during their preseason. Data were assessed by a logistic regression analysis calculating odds ratios. The primary outcome was processed to assess the relationship between scapular dyskinesis and other variables at the preseason. The secondary outcome was processed to assess an influence of scapular dyskinesis to shoulder discomfort during their regular season that were reassigned by second questionnaires. RESULTS: Scapular dyskinesis was identified in 33 (32%) shoulders, and type III was prominent. Scapular dyskinesis was significantly associated with shoulder discomfort (OR [odds ratio] = 4.4), and was also associated with variables of the affected shoulder. In addition, the players with asymptomatic scapular dyskinesis at the preseason would have high incident with shoulder discomfort during their regular season (OR = 3.6). CONCLUSIONS: Scapular dyskinesis was associated significantly with both subjective and objective symptoms of the affected shoulder. These appearances may be of particular relevance in the early screening of chronic shoulder disorders in the rugby population. Further study to investigate and evaluate its reliability is needed to characterize its impact on the participants in collision sports.

Resveratrol improves hippocampal atrophy in chronic fatigue mice by enhancing neurogenesis and inhibiting apoptosis of granular cells.

Neuroimaging evidence showed structural and/or functional abnormalities existing in the central nervous system, especially the hippocampus, in chronic fatigue syndrome (CFS) patients. However, its pathophysiologic mechanisms are unclear in part due to the lack of an applicable animal model. We established a chronic fatigue murine model by six repeated injections of Brucella abortus antigen to mice, which was manifested as reduced daily running activity and hippocampal atrophy. Thereafter, resveratrol, a polyphenolic activator of sirtuin 1, was used for treatment in this model. Daily running activity was increased by more than 20%, and the hippocampus was enlarged after 4-week resveratrol therapy. Furthermore, resveratrol inhibited neuronal apoptosis and expression of hippocampal acetylated p53 in the fatigue mice. Resveratrol also improved neurogenesis and expression of brain-derived neurotrophic factor mRNA in the hippocampus. We concluded that repeated injection of B. abortus antigen could induce hypoactivity and hippocampal atrophy in mice. Resveratrol may be effective for improving fatigue symptoms and enlarging the atrophic hippocampus by repressing apoptosis and promoting neurogenesis.

Conjugated macrocycles: concepts and applications.

One of the most important objectives in materials, chemical, and physical sciences is the creation of large conjugated macrocycles with well-defined shapes, since such molecules are not only theoretically and experimentally interesting but also have potential applications in nanotechnology. Fully unsaturated macrocycles are regarded as models for infinitely conjugated π systems with inner cavities, and exhibit unusual optical and magnetic behavior. Macrocycles have interior and exterior sites, and site-specific substitution at both or either site can afford attractive structures, such as 1D, 2D, and 3D supramolecular nanostructures. These nanostructures could be controlled through the use of π-extended large macrocycles by a bottom-up strategy. Numerous shape-persistent π-conjugated macrocycles have been synthesized, but only a few are on the nanoscale. This Review focuses on nanosized π-conjugated macrocycles (>1 nm diameter) and giant macrocycles (>2 nm diameter), and summarizes their syntheses and properties.

Urosepsis secondary to ureterosciatic hernia corrected with ureteral stent placement: a case report and literature review.

BACKGROUND: Ureterosciatic hernia is a rare type of pelvic floor herniation that occurs through the sciatic foramen. The resulting ureteral obstruction may lead to hydronephrosis and to further complications including urinary tract infection and urosepsis. There have been 30 reported cases of ureterosciatic hernia. Ureteral stenting and surgical repair have been used as treatment options. CASE PRESENTATION: We report the case of an 86-year-old woman who was transferred to Tokyo Metropolitan Bokutoh Hospital with symptoms of fever and septic shock. Her computed tomography scan revealed left hydronephrosis and deviation of the left ureter into the sciatic foramen; she was therefore diagnosed with a left ureteral sciatic hernia and admitted in our intensive care unit for further treatment with resuscitative fluids, vasopressors, and antibiotics. Following a retrograde insertion ureteral catheter insertion, ureteral incarceration was relieved, and a double-J ureteral stent was placed in situ. Antibiotic treatment was initiated, and the patient's hemodynamic status gradually improved. CONCLUSIONS: Although ureterosciatic hernia is a rare disorder, it is associated with serious complications including urinary tract infection with sepsis, which may warrant urgent corrective procedure to relieve the structural obstruction. Treatment may be conservative or surgical, though treatment with ureteral stent placement may be a favorable approach in elderly patients with multiple comorbidities presenting with urosepsis.

Traditional chinese medicine for chronic fatigue syndrome.

More and more patients have been diagnosed as having chronic fatigue syndrome (CFS) in recent years. Western drug use for this syndrome is often associated with many side-effects and little clinical benefit. As an alternative medicine, traditional Chinese medicine (TCM) has provided some evidences based upon ancient texts and recent studies, not only to offer clinical benefit but also offer insights into their mechanisms of action. It has perceived advantages such as being natural, effective and safe to ameliorate symptoms of CFS such as fatigue, disordered sleep, cognitive handicaps and other complex complaints, although there are some limitations regarding the diagnostic standards and methodology in related clinical or experimental studies. Modern mechanisms of TCM on CFS mainly focus on adjusting immune dysfunction, regulating abnormal activity in the hypothalamic-pituitary-adrenal (HPA) axis and serving as an antioxidant. It is vitally important for the further development to establish standards for 'zheng' of CFS, i.e. the different types of CFS pathogenesis in TCM, to perform randomized and controlled trials of TCM on CFS and to make full use of the latest biological, biochemical, molecular and immunological approaches in the experimental design.

A Kampo Medicine, Boi-ogi-to, Inhibits Obesity in Ovariectomized Rats.

In women facing menopause, end of menstrual activity is accompanied by lower levels of estrogen and gradual weight gain. Postmenopausal weight gain sounds an alarm for women's health and may lead to hyperlipidemia, a lipid increase and glucose intolerance. These phenomena are connected to lifestyle-related diseases such as hypertension, type II diabetes mellitus, arteriosclerosis and metabolic syndrome, making it essential to prevent weight gain in women. A Kampo medicine, Boi-ogi-to, is traditionally used to treat obese conditions, but the mechanism has not yet been investigated. In this experiment, we tested the antiobesity properties of Boi-ogi-to in ovariectomized rats by measuring changes of serum cytokine levels and adipocytokines in fat cells. After treatment with this extract for 6 weeks (20-week-old rats), we found that there was a significant weight decrease in rats treated with Boi-ogi-to as compared with that in the control group. Serum tumor necrosis factor (TNF)-α levels increased significantly in a dose-dependent manner. Gene expression of adipose tissue in uterus also dose dependently showed a significant increase of TNF-α levels, suggesting that secretion of TNF-α by fat cells might play a role in the ability of Boi-ogi-to to inhibit weight gain. While peroxisome proliferators-activated receptor-γ and adiponectin levels did not show a significant difference as compared with those in the control, levels of mRNA expression showed a tendency to increase dose dependently. Resistin did not show any significant change. These results suggest that Boi-ogi-to might be useful for the prevention of obesity that occurs in women with reduction of estrogen.

Hochu-ekki-to combined with interferon-gamma moderately enhances daily activity of chronic fatigue syndrome mice by increasing NK cell activity, but not neuroprotection.

The purpose of this study was to evaluate the beneficial effect of Hochu-ekki-to (TJ-41) combined with interferon-gamma (IFN gamma) on daily activity, immunological and neurological alternation in a mouse model of chronic fatigue syndrome (CFS). CFS was induced by 6 times of repeated injection of Brucella abortus antigen every 2 weeks. Both single TJ-41 and TJ-41 combined with IFN gamma increased running activity and thymus weight of CFS mice, while thicker thymic cortex together with elevation of natural killer cell activity was only found in the combined treatment group. No significant improvement was observed in the atrophic brain and decreased expression level of brain-derived neurotrophic factor and Bcl-2 mRNA in hippocampus in both treatment groups. Our results suggest that TJ-41 combined with IFN gamma might have a protective effect on the marked reduction in the activity in a model of CFS via normalization of host immune responses, but not neuroprotection.

Brain atrophy in a murine model of chronic fatigue syndrome and beneficial effect of Hochu-ekki-to (TJ-41).

Brain-derived neurotrophic factor (BDNF) is associated with the main symptoms of chronic fatigue syndrome (CFS) and neuron apoptosis. Nevertheless, no study has been performed directly to explore the relationship between CFS, BDNF and neuron apoptosis. We induced a CFS model by six injections of killed Brucella abortus antigen in BALB/c mice and treated them with Hochu-ekki-to (TJ-41). Daily running activity, body weight (BW), ratio of cerebral weight to BW (CW/BW) and expression levels of BDNF and Bcl-2 mRNA in the hippocampus were determined. The daily activity and CW/BW decreased significantly in the CFS model. BDNF and Bcl-2 mRNA expression levels in the hippocampus were suppressed in the CFS model and TJ-41 treated mice, while no significant difference was found between them. We improved a murine model to investigate the relationship between CFS and brain dysfunction. In this model, reduced daily activity might have been associated with decreased hippocampal BDNF mRNA expression, hippocampal apoptosis and brain atrophy. TJ-41 increased the daily running activity of the model, which was independent of brain recovery.

Synthesis of nonaphenylenes and dodecaphenylenes using electron-transfer oxidation of Lipshutz cuprates and formation of nanostructural materials from hexadodecyloxynonaphenylene.

Nonaphenylenes and dodecaphenylenes have been synthesized by using electron-transfer oxidation of Lipshutz cuprates with duroquinone. Oxidation of the Lipshutz cuprate derived from 4,4''-dibromo-o-terphenyl 3a in THF produced nonaphenylene 1a in 46% yield, whereas the similar oxidation of the Lipshutz cuprates derived from 4,4''-diiodo-4',5'-dialkyl-o-terphenyls 3b-d in ether afforded the corresponding nonaphenylenes 1b-d and dodecaphenylenes 2b-d in moderate total yields. In the case of 4,4''-diiodo-4',5'-didodecyloxy-o-terphenyl 3e as the starting material, oxidation of the corresponding Lipshutz cuprate in ether or THF only led to the formation of nonaphenylene 1e. Both nonaphenylenes 1a-e and dodecaphenylenes 2b-d are unreactive to light, atmospheric oxygen, and prolonged heating. These oligophenylenes showed strong UV absorption and fluorescent emission and exhibited some redox properties on CV analysis. Moreover, hexadodecyloxynonaphenylene 1e exhibits different nanostructures on the surface and in solution to form a film by casting a solution of 1e in cyclohexane, benzene, chloroform, THF, or diisopropyl ether (IPE) and nanofibers from IPE-MeOH (1:1), indicating different absorption and emission spectra and XRD patterns. The absorption maxima of THF solution, fiber, and film are in the order of 1e film (315 nm) > fiber (302 nm) > solution (295 nm), whereas the emission maxima are in the order of 1e fiber (425 m) > solution (418 nm) > film (401 nm). XRD analysis revealed that 1e aligns laterally on a glass or silicon surface to form a thin film with a lamella structure; however, it forms a nanofiber with a Lego-like stacking structure without pi-pi stacking interaction of the aromatic rings. Reflecting the different nanostructures of the 1e film and fiber, a spin-coated 1e film is found to be effective in detecting the vapor of explosives due to the intercalation of nitroaromatics to the cracked surface of the loosely stacked 1e. In contrast, the 1e fiber is not effective in detection of nitroaromatics but exhibits fluorescence anisotropy. The maximum fluorescence intensity is obtained in a direction perpendicular to the longitudinal axis of the fiber, indicating the stacking direction to be parallel to the longitudinal axis of the fiber.

Midterm Clinical Results in Rugby Players Treated With the Bristow Procedure.

BACKGROUND: Although surgical shoulder stabilization by coracoid transfer is effective for collision athletes and has a low reinjury rate, no reports have described the midterm results of this procedure in specific patient cohorts of sufficient number or provided subjective assessments of these patients. PURPOSE: To evaluate midterm results after treatment of shoulder instability with the Bristow procedure in a large cohort of rugby players. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: This study included 176 shoulders of 152 competitive rugby players who underwent shoulder stabilization surgery (Bristow procedure with Bankart repair) with a mean follow-up of 4 years (minimum of 2 years) in our institute. The primary outcome measure was the difference in the presurgical and postsurgical functional Rowe score and Western Ontario Shoulder Instability index (WOSI) score and factors affecting these scores. Complication rates and associated factors were also investigated. RESULTS: In total, 176 shoulders of 152 patients underwent the Bristow procedure with Bankart repair, and 93.2% of the players returned to their preinjury competition level at a mean of 6.3 months postoperatively. All Rowe and WOSI scores were significantly improved after surgery. The numbers of shoulders with functional failure as indicated by the Rowe score, WOSI score, and inability to return to the previous level of play were 28 (15.9%), 54 (30.7%), and 12 (6.8%), respectively. Multiple logistic regression analyses demonstrated that reinjury after surgery (odds ratio [OR] = 35.1) and the number of shoulder dislocations (OR = 11.2-11.4) negatively affected the competition level after return to play, while reinjury (OR = 11.1-17.8), the number of shoulder subluxations (OR = 1.1-2.9), injury in the dominant shoulder (OR = 1.2-2.2), and large bone defects (OR = 1.1-11.5) negatively affected functional scores. Reinjury after shoulder stabilization occurred in 6 of 176 shoulders (3.4%). Multiple logistic regression analysis demonstrated that reinjury after surgery occurred more frequently in players at lower versus higher grade levels of competition (OR = 21.0). Although differences were not significant, a trend was noted toward higher postoperative reinjury rates in forward players, those in the upper categories (professional and college), and those with injury in the nondominant shoulder. CONCLUSION: The Bristow procedure provides good midterm outcomes for competitive collision athletes, while postsurgical reinjury, the number of preoperative dislocations and subluxations, and large bone defects negatively affect postsurgical shoulder function. This information may be useful for treatment of shoulder dislocations in collision athletes.

Induction Murine Models of Chronic Fatigue Syndrome by Brucella abortus Antigen Injections: Is Anemia Induced or Not?

To investigate whether Brucella abortus (BA) antigen injections lead to anemia, and to establish an appropriate Chronic Fatigue Syndrome (CFS) animal model by BA injections, 6 repeated injections of BA antigen were fulfilled every 2 weeks. At a high dose of 1∗10(10) particles/mouse, anemia was induced within 2 weeks and then recovered a lot at the end of the research, while at a moderate dose of 1∗10(8) (3 injections) shifting to 1∗10(9)/mouse (3 injections) anemia was absent. In both groups running wheel activity remained very low even 6 weeks after the last injection.

Habitual exercise did not affect the balance of type 1 and type 2 cytokines in elderly people.

The purpose of this study was to test the hypothesis that regular exercise training in elderly people affects the type 1/type 2 balance. Nine elderly women who train by walking (mean+/-S.E.M., age 63+/-1 years, VO2 peak 32.2+/-1.0 ml kg(-1) min(-1)), 12 age-matched untrained women (63+/-1 years, 27.8+/-0.9 ml kg(-1) min(-1)), and nine young untrained women (26+/-1 years, 37.8+/-1.3 ml kg(-1) min(-1)) participated in the study. We measured interferon gamma (IFN-gamma), IL-2, and IL-4 in CD4+ and CD8+ T cells, to compare type 1 and type 2 T cells. The number of CD4+ cells expressing intracellular IFN-gamma (CD4+/IFN-gamma cell) significantly higher in the elderly trained than in the young (P<0.01). The number of CD8+/IL-2 cells was significantly higher in the elderly trained than in the elderly untrained (P<0.05). The number of CD8+/IL-4 cells was significantly higher in the young than in the elderly untrained (P<0.01). No significant differences were apparent in the IFN-gamma/IL-4 ratio within CD4+ and CD8+ cells from the three groups. These results might indicate that the effect of age on the balance of type 1/type 2 T cells was stronger than the effect of physical training.

Evaluation of the outcome of traumatic thoracic aortic rupture in patients in a trauma and critical care center.

OBJECTIVES: Multiple injuries may lead to traumatic thoracic aortic rupture (TTAR), which can be fatal. We evaluated the relationship between the clinical findings and outcomes of 26 patients with TTAR who were treated at our institution. METHODS: A total of 26 patients (men, 21; women, 5; average age, 45.8 ± 19.6 years) with a diagnosis of TTAR received from 1999 to 2009 were studied. We categorized patients into groups based on the outcome (survival or death) and investigated the relationship between the outcome and the following factors: injury mechanism, vital signs, other combined injuries, injury severity score (ISS), revised trauma score, and probability of survival (Ps). RESULTS: Of the 26 TTAR patients, 7 underwent emergency operations, 5 underwent delayed operations, 1 received conservative treatment, and 13 suffered cardiopulmonary arrest immediately after consultation and died. Of the 13 patients who died, 11 died within 2 hours after injury because of bleeding. Two of the 7 patients who underwent emergency operations died within 1 day of consultation, whereas all those who underwent delayed operations survived. Patients who underwent TTAR repair had a relatively favorable outcome. Analysis of the relationship between the clinical data and outcome showed that a young age was significantly correlated with survival, and that the Glasgow coma scale (GCS), heart rate, respiratory rate, or occurrence of shock were not significantly related to the outcome. The abbreviated injury scale (AIS) was used to score the severity of multiple injuries, and ISS was calculated from the AIS score. ISS was significantly higher in the death group (P = 0.007). ISS did not significantly differ among body parts (P = 0.077), but ISS of the extremities was higher than those of other parts. Pelvic fractures were frequent in the death group. Our strategy, whereby the patient initially underwent pelvic external fixation followed by TTAR repair was found to be very effective. The P-values calculated by the trauma and injury severity score method were significantly higher in the survival group (both, P = 0.007). CONCLUSION: To treat TTAR, it is important to accurately evaluate the damage due to multiple injuries and apply an appropriate treatment strategy. Immediate repair of TTAR after bleeding due to combined injury improves the outcome. (English Translation of Jpn J Vasc Surg 2012; 21:5-9).

Significance of Kampo, Japanese traditional medicine, in the treatment of obesity: basic and clinical evidence.

The cause of obesity includes genetic and environmental factors, including cytokines derived from adipocytes (adipo-cytokines). Although drug therapy is available for obesity, it is highly risky. Our main focus in this review is on the traditional form of Japanese medicine, Kampo, in the treated of obesity. Two Kampo formulas, that is, bofutsushosan () and boiogito (), are covered by the national health insurance in Japan for the treatment of obesity. Various issues related to their action mechanisms remain unsolved. Considering these, we described the results of basic experiments and presented clinical evidence and case reports on osteoarthritis as examples of clinical application of their two Kampo medicine. Traditional medicine is used not only for treatment but also for prevention. In clinical practice, it is of great importance to prove the efficacy of combinations of traditional medicine and Western medicine and the utility of traditional medicine in the attenuation of adverse effects of Western medicine.

Role of Kampo medicine in integrative cancer therapy.

Clinical trials to date demonstrate that standard cancer treatments are currently the most efficient treatments for large numbers of cancer patients. Cancer treatments will increasingly require approaches that allow patients to live with cancer, by increasing their natural healing power and tumor immunity, as well as attenuating the progression of their cancers, instead of only attacking the cancer cells directly. Complementary and alternative medicine, including Kampo medicine, compensates for the drawbacks of western medicine by increasing patients' self-defense mechanisms. In Japan, clinicians who have studied both western medicine and Kampo treat cancer patients by fusing the two medical systems into a unitary one. The goal of the system is to assist the functional maintenance and recovery of the living body complex with the physical, mental, social, and spiritual balance, rather than addressing direct antitumor effects. In this review, we describe the usefulness of Kampo medicine, especially juzentaihoto, and outline the reports on evidence, in addition to the report on an attitudinal survey about the use of Kampo medicine in cancer treatment in Japan.

Significance of Kampo, traditional Japanese medicine, in supportive care of cancer patients.

The current standard treatment for cancer is a multidisciplinary therapy whereby various types of treatment are properly combined. Chemotherapy with multiple anticancer drugs is now common, and traditional, complementary, and alternative therapies are adopted as supportive measures. Medical care in Japan is distinguished by the ability for patients to access both Western and Kampo medical cares at the same time. There is a high degree of trust in the safety of Kampo therapies because they are practiced by medical doctors who are educated with fundamental diagnosis of Western medicine. Highly reliable clinical studies are being published, demonstrating that palliative or supportive care for cancer patients using Kampo preparations alleviates adverse effects of chemotherapy or radiotherapy. This paper reports the circumstances around cancer care in Japan where traditional therapeutic Kampo formulas are used for patients undergoing cancer treatment with cutting-edge chemotherapy, specifically to alleviate adverse effects of anticancer drugs.